Research Project 2: ICCS IN LUNG CANCER: EVALUATING SURVIVAL BENEFITS Project Summary: The prognosis for Non-Small Cell Lung Cancer patients remains poor despite recent advances in anti-cancer therapies, with a median lifespan of eight months. The diagnosis of advanced lung cancer often inflicts fear, despair, and hopelessness on patients and loved ones. For lung cancer patients in particular, a population where palliation rather than cure is often the focus, interventions addressing communication about various types of suffering are crucial to quality of life (QOL). Our current CECCR Lung Cancer Clinician Integration (LCCI) project was designed to measure the impact of CHESS (Comprehensive Health Enhancement Support System), a non-commercial, home-based system created by clinical, communication, and decision scientists at the University of Wisconsin, on lung cancer caregivers' QOL and bereavement. However, preliminary data analysis has yielded an unanticipated finding that such an ICCS may even have a survival benefit. Specifically, one year survival was significantly increased in the CHESS group (50%) compared to the Internet (34.2%). Given the LCCI project did not focus on patient outcomes, it is critical to follow-up these findings with a wellformulated study designed and powered to address specific hypotheses of the nature of this effect. Given the bleak prognosis and complex symptom profile of lung cancer patients, improved quality of life for patients with advanced lung cancer is very important, as anticancer therapy usually improves survival by only a few months. In addition to examining the quality of life outcomes from patient use of an ICCS during advanced cancer treatment, the proposed research will be the first assessment to our knowledge of whether providing patients and caregivers with an ICCS can affect length of survival in an advanced lung cancer setting. Accordingly, this research will add new understanding to the role of an ICCS, particularly for advanced cancer patients. The proposed study leverages Self Determination Theory (SDT) to conceptualize CHESS services and effects. SDT focuses on an individual's psychological needs for developing competence, autonomy, and relatedness. Accordingly, CHESS use, by enhancing competence, autonomy, and relatedness, should lead to improved patient quality of life as compared to usual care. This will result in more effective disease management, and accordingly CHESS may also extend length of survival in this advanced stage population. Using sites in Wisconsin, Houston, and Chicago, we will randomly assign 376 advanced lung cancer patients to two study arms: 1) a patient control group receiving Usual Care (including access to a computer and Internet); and 2) CHESS for Lung Cancer (CHESS-LC) delivered via the Internet for personal computer access. Patients will be invited to have a caregiver also participate, although this is not required. Patients (and caregivers) will be followed for 18 months or until the patient dies. Our research will test two primary hypotheses: that compared to a Usual Care control, CHESS-LC will significantly improve (1) patient quality of life and (2) length of overall survival. As secondary outcomes we will: 1) Examine the effects of CHESS use on the SDT constructs of competence, autonomy, and relatedness; 2) Examine the factors that moderate the effect of CHESS use on SDT constructs; 3) Examine whether competence, autonomy and relatedness mediate the effects of CHESS use on QOL; 4) Examine whether treatment participation mediates the effect QOL has on survival; and 5) Characterize the effects of the quality of the patient-caregiver relationship (relatedness) on patient QOL over time and whether this association differs depending on the combined effects of gender and social role. This CECCR II proposal focuses on applications of CHESS, a computer program aimed to decrease unnecessary cancer burden through provision of information and support to cancer patients, survivors and family caregivers. This Prolonging Life study will examine the potential for CHESS to not only impact psychosocial outcomes (QOL), but also length of survival in an advanced stage lung cancer population.